Provider Demographics
NPI:1730381146
Name:GRUENKE, ALLEN CONRAD (BA)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:CONRAD
Last Name:GRUENKE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9009 CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1582
Mailing Address - Country:US
Mailing Address - Phone:313-389-7527
Mailing Address - Fax:313-382-7906
Practice Address - Street 1:26184 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2084
Practice Address - Country:US
Practice Address - Phone:313-389-7527
Practice Address - Fax:313-382-7906
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker